Gender differences in HIV disease progression and treatment outcomes among HIV patients one year after starting antiretroviral treatment (ART) in Dar es Salaam, Tanzania

Abstract

BackgroundWe investigated gender differences in treatment outcome during first line antiretroviral treatment (ART) in a hospital setting in Tanzania, assessing clinical, social demographic, virological and immunological factors.MethodsWe conducted a cohort study involving HIV infected patients scheduled to start ART and followed up to 1 year on ART. Structured questionnaires and patients file review were used to collect information and blood was collected for CD4 and viral load testing. Gender differences were assessed using Kruskal-Wallis test and chi-square test for continuous and categorical data respectively. Survival distributions for male and female patients were estimated using the Kaplan-Meier method and compared using Cox proportional hazards models.ResultsOf 234 patients recruited in this study, 70% were females. At baseline, women had significantly lower education level; lower monthly income, lower knowledge on ARV, less advanced HIV disease (33% women; 47% men started ART at WHO stage IV, p = 0.04), higher CD4 cell count (median 149 for women, 102 for men, p = 0.02) and higher BMI (p = 0.002). After 1 year of standard ART, a higher proportion of females survived although this was not significant, a significantly higher proportion of females had undetectable plasma viral load (69% women, 45% men, p = 0.003), however females ended at a comparable CD4 cell count (median CD4, 312 women; 321 men) signifying a worse CD4 cell increase (p = 0.05), even though they still had a higher BMI (p = 0.02). The unadjusted relative hazard for death for men compared to women was 1.94. After correcting for confounding factors, the Cox proportional hazards showed no significant difference in the survival rate (relative hazard 1.02).ConclusionWe observed women were starting treatment at a less advanced disease stage, but they had a lower socioeconomical status. After one year, both men and women had similar clinical and immunological conditions. It is not clear why women lose their immunological advantage over men despite a better virological treatment response. We recommend continuous follow up of this and more cohorts of patients to better understand the underlying causes for these differences and whether this will translate also in longer term differences.

Differential effects of sex in a West African cohort of HIV‐1, HIV‐2 and HIV‐1/2 dually infected patients: men are worse off

“…Conflicting data have been reported on sex differences in CD4 cell count recovery after initiation of ART . We found no differences in CD4 cell count recovery after adjusting for baseline CD4 cell count and time from baseline CD4 cell count.…”

“…In contrast, other studies have reported a better immunological outcome in women . Two studies from Uganda and Tanzania showed that women are more likely to be virally suppressed on treatment, but the CD4 cell count change was the same as in men .…”

Factors Associated with Adverse Therapeutic Outcomes in People Living with HIV (PLHIV) Monitored in Roi Baudouin Health Care Center, Dakar, Senegal

“…The adverse events relating to treatment was associated with young age in our series. This association corroborates what has been described in several studies [38] [39]. The reasons which are mostly mentioned in the non-optimization of ART in the young subject are the low compliance [40], the long duration of exposure [41], the inadequacy of dosage [42].…”

Sociodemographic, lifestyle and therapeutic predictors of 2-year survival in HIV-infected persons receiving antiretroviral therapy in Benin

“…5 Another influence of sex was reported in Dar es Salam in Tanzania, where researchers determined that one-year after ART initiation, women have a better immunological response, with a high rate of undetectable virus load. 15 A high adherence to ART was associated with a decreased death rate, which has also been described elsewhere; however, 12 months of inpatient care increases the death rate. 1,5 The benefits of highly active ART in the treatment of HIV infection have been well described and include viral suppression, CD4 lymphocyte repletion, and durable reductions in HIV infection-related opportunistic diseases and death.…”